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Runner's Knee? An Osteopath’s approach

  • Writer: integratedsands
    integratedsands
  • Aug 28, 2025
  • 3 min read

Written by By Dr Felix Adamson-Walter (Osteopath) 


Running

Runner’s knee, medically known as Patellofemoral Pain Syndrome (PFPS), is one of the most common causes of knee pain in runners and active individuals. It usually presents as a dull, aching pain around or behind the kneecap that often worsens with running, squatting, or climbing stairs.


PFPS develops when the tissues and cartilage around the kneecap are irritated due to excessive loading or poor mechanics (or a combination of both). Common contributing factors include:


  • Sudden increases in training distance or intensity


  • Weakness in the quadriceps, glutes, hip stabilisers, calves or feet


  • Poor knee tracking mechanics during running or squatting


  • Poor foot mechanics (too much or too little movement and control)


  • Worn-out running shoes


  • Tightness in the quadriceps, calves, or hip flexors


Treatment

As an Osteopath, I would assess how your whole body is moving to understand what is leading to the overload at your knee.


Treatment can include hands-on techniques to ease tight muscles, joint mobilisation to improve movement, and corrective exercises to build strength and stability where you have deficits. This would be paired with guidance on your training load so you can return to running with less pain.


Running

Management

Management focuses on reducing the movements that directly irritate the knee, improving mechanics, and building strength in the muscles that support the knee. Some helpful tools I use with my patients are:


  1. Relative Rest: Replace painful running with lower-impact options such as cycling, swimming, or elliptical training until symptoms settle.


  1. Strengthening: Prioritise quadriceps (particularly the VMO), glute medius, and glute max. Single-leg exercises are especially effective.


  1. Mobility Work: Stretch and mobilise tight hip flexors, quadriceps, and calves. Foam rolling can help reduce tension to relieve symptoms.


  1. Footwear Check: Make sure your shoes provide enough support and cushioning.


  1. Load Management: Avoid sudden spikes in mileage or hill training. Progress gradually and schedule recovery weeks.


  1. Holistic Wellbeing: Prioritise sleep, nutrition, and hydration as they are essential for tissue repair and overall recovery.


Running

Preventing PFPS

Prevention is centred on consistency and balance. To reduce your risk of PFPS:


  • Progress training gradually, following the 10 percent rule


  • Incorporate lower body strength, plyometrics, and mobility into your weekly program


  • Include single-leg balance and stability drills


  • Vary running surfaces where possible


  • Replace shoes every 500-700 kilometres


  • Listen to your body and address early niggles before they progress


Runner’s knee can be frustrating, but with early treatment and the right approach to management, you can recover fully and continue running without pain. Strengthening, mobility, and load management are the foundation of long-term knee health.


If you need some extra support to get back to running pain-free, book an appointment with Felix, below. Alternatively, give us a call on 0425 876 929 to discuss your needs.





Osteo

References

Collins, N. J., Bierma-Zeinstra, S. M., Crossley, K. M., van Linschoten, R. L., Vicenzino, B., & van Middelkoop, M. (2018). Prognostic factors for patellofemoral pain: A multicentre observational analysis. British Journal of Sports Medicine, 52(10), 659–667. https://doi.org/10.1136/bjsports-2017-098356


Neal, B. S., Lack, S. D., Lankhorst, N. E., Raye, A., Morrissey, D., & van Middelkoop, M. (2019). Risk factors for patellofemoral pain: A systematic review and meta-analysis. British Journal of Sports Medicine, 53(5), 270–281. https://doi.org/10.1136/bjsports-2018-099128


Rathleff, M. S., Rathleff, C. R., Crossley, K. M., & Barton, C. J. (2014). Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. British Journal of Sports Medicine, 48(14), 1088. https://doi.org/10.1136/bjsports-2013-093305


van der Heijden, R. A., Lankhorst, N. E., van Linschoten, R., Bierma-Zeinstra, S. M., & van Middelkoop, M. (2015). Exercise for treating patellofemoral pain syndrome: An abridged version of Cochrane systematic review. European Journal of Physical and Rehabilitation Medicine, 51(1), 110–121.


Willy, R. W., & Hoglund, L. T. (2019). Patellofemoral pain. Journal of Orthopaedic & Sports Physical Therapy, 49(9), CPG1–CPG95. https://doi.org/10.2519/jospt.2019.0302

 
 
 

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